Pepsin as a Marker of Reflux Aspiration in Children With Esophageal Atresia: A Pilot Study

Upendran, Yadhavan; Leach, Steven T.; Singh, Harveen; McBride, James H.; Thomas, Paul S.; Belessis, Yvonne; Krishnan, Usha

doi:10.3389/fped.2020.00094

Cited by 8 publications

(7 citation statements)

References 34 publications

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“…However, ELISA must be performed in a specific laboratory, which is a major disadvantage in clinical practice. 13 Peptest is a simple, convenient, and patient‐accepted method, 14 with a threshold of 16 ng/ml. However, some researchers have found that the concentration of salivary pepsin in healthy Chinese people is 24.22 ± 6.94 ng/ml.…”

Section: Introductionmentioning

confidence: 99%

Multitime point pepsin testing can double the rate of the diagnosis of laryngopharyngeal reflux

Zhang

et al. 2021

Laryngoscope Investig Oto

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Objective: To study the value of multitime point salivary pepsin testing (MTPSPT) for the diagnosis of laryngopharyngeal reflux (LPR).Study Design: Prospective noncontrolled.Methods: For patients who met the enrollment criteria, the reflux symptom index (RSI) and reflux finding score (RFS) were calculated and salivary pepsin testing was performed. The pepsin test was performed every hour from 7:00 a.m. to 6:00 p.m. by collecting fresh saliva samples. A single positive test result was needed for the diagnosis of LPR. The consistency in the diagnosis of LPR between the two methods was compared with the weighted Cohen's kappa statistic.Results: A total of 204 patients were included. The kappa value between the two methods was 0.566 (p = .00). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MTPSPT were 76.43%, 85.94%, 92.24%, and 62.5%, respectively. We also compared a single pepsin measure at 7 a.m. with the screening results based on the RSI and RFS, and found a much lower kappa agreement value (0.223, p = .00). The sensitivity, specificity, PPV, NPV, and false-negative rate of pepsin testing at 7 a.m. (fasting) were 37.86%, 92.18%, 91.38%, 40.41%, and 58.57%, respectively. Conclusion:The use of the result of a single salivary pepsin test in the morning yields a relatively higher rate of missed diagnosis of LPR, and multitime point testing through a day increased the accuracy and sensitivity of detection of LPR twofold compared to a single morning fasting sample.

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Section: Introductionmentioning

confidence: 99%

Multitime point pepsin testing can double the rate of the diagnosis of laryngopharyngeal reflux

Zhang

et al. 2021

Laryngoscope Investig Oto

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“…In a study concerning infants with laryngomalacia, salivary pepsin was detected in 81% of patients versus 12.5% of controls [ 96 ]. In another study, salivary pepsin was detected in 83% of children with corrected esophageal atresia, and this was significantly associated with GERD symptoms or wheezing [ 26 ]. Moreover, pepsin testing on BAL fluid samples seems to have a high positive predictive value and may be a feasible means to identify pediatric patients with chronic respiratory symptoms due to aspiration associated with LPR [ 53 ].…”

Section: Resultsmentioning

confidence: 99%

Pediatric Laryngopharyngeal Reflux in the Last Decade: What Is New and Where to Next?

Sofokleous

Παπαδοπούλου

Giotakis

et al. 2023

JCM

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Background: Laryngopharyngeal reflux may affect people of any age; still, most of the accumulated knowledge concerns adults, and evidence regarding pediatric populations remains relatively restricted. This study aims to review the most recent and emerging aspects of pediatric laryngopharyngeal reflux from the last ten years. It also attempts to identify gaps in knowledge and highlight discrepancies that future research should urgently address. Methods: An electronic search of the MEDLINE database was conducted, limited to January 2012 through December 2021. Non-English language articles, case reports, and studies that concerned a purely or predominantly adult population were excluded. The information from the articles with the most relevant contribution was initially categorized by theme and subsequently synthesized into a narrative form. Results: 86 articles were included, of which 27 were review articles, eight were surveys, and 51 were original articles. Our review systematically maps the research done in the last decade and provides an updated overview and the current state-of-the-art in this subject. Conclusions: Despite discrepancies and heterogeneity in accumulating research, evidence gathered so far endorses a need for refining an escalating multiparameter diagnostic approach. A step-wise therapeutic plan appears to be the most reasonable management approach, starting with behavioral changes for mild to moderate, uncomplicated cases and escalating to personalized pharmacotherapy options for severe or nonresponsive cases. Surgical options could be considered in the most severe cases when potentially life-threatening symptoms persist despite maximal medical therapy. Over the past decade, the amount of available evidence has been gradually increasing; however, its strength remains low. Several aspects remain markedly under-addressed, and further adequately powered, multicenter, controlled studies with uniformity in diagnostic procedures and criteria are urgently needed.

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“…Отбор больных для проведения качественных проб на микроаспирацию осуществлялся исследователями после ответов на скрининговую анкету, позволяющую клинически заподозрить ГЭР [47]. Согласно Pediatric Gastroesophageal Reflux Clinical Practice Guidelines (2018), типичный рефлюксный синдром может быть диагностирован на основании характерных симптомов, без инструментального обследования [10,27]. Качественный лактозный тест был модифицирован авторами (по сравнению с 1997 годом), определение лактозы в исследуемом материале проводили с помощью измерения коэффициента пропускания световой волны длиной 540 нм на фотокалориметре КФК 2-МП, что позволило значительно увеличить чувствительность данной пробы.…”

Section: Discussionunclassified

“…Первый -прямой путь через микроаспирацию кислого содержимого желудка и пепсина, дуоденального содержимого в виде желчных кислот и трипсина, индуцирующих бронхоконстрикцию; второй -косвенный, опосредованный путь [25]. В первом случае раздражение происходит при попадании содержимого в ротоглотку и гортаноглотку с микроаспирацией или без нее в нижние дыхательные пути [26,27]. При втором механизме проявления обусловлены вагусопосредованным пищеводно-трахеально-бронхиальным рефлексом, индуцирующим воспаление слизистой оболочки бронхов, возникающим в результате раздражения нижнего отдела пищевода желудочно-кишечным содержимым.…”

Section: Introductionunclassified

Microaspiration in GER as one of the causes of bronchial asthma exacerbation and the occurrence of chronic cough in children. History of the problem and diagnostics

Fedorov

Rybakova

Goreva

2021

jour

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The purpose of the review: to analyze the evolution of the views of clinicians and researchers on the relationship between gastroesophageal reflux and is extraesophageal bronchial manifestations, and the stages of the formation of the diagnosis of microaspiration of the lower respiratory tract in children.Materials and methods. Sarch in electronic databases: Elibrary, Federal Electronic Medical Library of the Ministry of Health of the Russian Federation, bibliographic database of articles on medical sciences, created by the US National Library of Medicine MEDLINE.Main statements. Diagnostics and treatment of gastroesophageal reflux and its extraesophageal manifestations both in the 20th century and at the beginning of the 21-st century present certain difficulties for pediatricians and pulmonologists. Currently, there are numerous domestic and foreign clinical guidelines created with the aim f improving diagnostics and approaches to the treatment of gastroesophageal reflux and "silent" microaspiration of the lower respiratory tract of the respiratory tract. However, the evidence base for the problem under discussion is rather limited, due to the lack of specificity of the symptoms of the disease and the absence of a "gold standard" diagnostics.Conclusion. The presented review gives information about non-invasive diagnosis of microaspiration in children with bronchial asthma and chronic cough what will help us decide on treatment, taking into account the concomitant gastroesophageal reflux. A non-invasive method for detecting lactose in the induced sputum of the respiratory tract and also an additional determination of the average cytochemical coefficient of macrophages can serve as an effective alternative to the verification of "silent" microaspiration in children with bronchial asthma and chronic cough.

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Pepsin as a Marker of Reflux Aspiration in Children With Esophageal Atresia: A Pilot Study

Cited by 8 publications

References 34 publications

Multitime point pepsin testing can double the rate of the diagnosis of laryngopharyngeal reflux

Multitime point pepsin testing can double the rate of the diagnosis of laryngopharyngeal reflux

Pediatric Laryngopharyngeal Reflux in the Last Decade: What Is New and Where to Next?

Microaspiration in GER as one of the causes of bronchial asthma exacerbation and the occurrence of chronic cough in children. History of the problem and diagnostics

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